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Issue 1313
Issue 1313: June 28, 2017

Ask the Experts
Ask the Experts—Question of the Week: How can I get yellow fever vaccine? Is there a vaccine shortage?...read more


TOP STORIES


IAC HANDOUTS


OFFICIAL RELEASES AND ANNOUNCEMENTS


WORLD NEWS


FEATURED RESOURCES


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING


CONFERENCES AND MEETINGS



TOP STORIES


CDC releases new online educational program on vaccine administration

CDC has released a new free, interactive, online educational program ("e-Learn") that serves as a useful introductory course or a great refresher on vaccine administration. Proper vaccine administration is critical for ensuring that vaccines are both safe and effective, but unfortunately, administration errors happen too frequently. Some of the most common vaccination administration errors include:
  • Not following the recommended immunization schedule
  • Administering improperly stored or expired vaccine and/or diluent
  • Administering the wrong vaccine—confusing look-alike or sound-alike vaccines such as DTaP/Tdap or administering products outside age indications

The self-paced e-Learn provides comprehensive training—using videos, job aids, and other resources to accommodate a variety of learning styles—and offers a certificate of completion and/or continuing education for those that complete the training.

The new course is available at https://www.cdc.gov/vaccines/ed/courses.html#elearn-vaccadmin.

For more information, please contact nipinfo@cdc.gov.

Related Links

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IAC provides summary of June 21–22 ACIP meeting, including the influenza vaccine vote

The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on June 21–22. In addition to the influenza vaccine vote described below, other topics discussed at the meeting included hepatitis A, herpes zoster, varicella, anthrax, mumps, and dengue virus vaccines. The committee also received an update on implementation of a new Vaccine Adverse Event Reporting System (VAERS) form, as well as plans for use of Stamaril yellow fever vaccine (Sanofi Pasteur, France) during a gap in production of U.S.-licensed YF-Vax (Sanofi Pasteur, USA). Finally, the group discussed meningococcal vaccine response in patients receiving eculizumab (Soliris, Alexion Pharmaceuticals). The June ACIP meeting agenda is available on the CDC website.

Influenza Discussion and Vote

Influenza vaccine was the major focus of the first day of discussions and provided the meeting’s only vote. Highlights of the influenza discussion and vote are provided below:

Influenza Surveillance Update for the 2016–2017 Season—This season’s activity was “moderate,” with peak activity occurring nationally in mid-February. Influenza A(H3N2) viruses predominated overall, but influenza B viruses have been reported more frequently since late March. The majority of circulating viruses were similar to those contained in the 2016–2017 season.

Vaccine Effectiveness (VE) Update—Preliminary data indicate the 2016–2017 vaccine reduced outpatient influenza visits by 42% for influenza A and B viruses and by 34% for influenza A(H3N2) viruses. This VE is comparable to previous A(H3N2) seasons when vaccine was similar to circulating viruses. Vaccine reduced influenza hospitalizations by 30% among all adults and by 37% among adults >65 years of age

VOTE: 2017–2018 Influenza Vaccine Recommendations:

  • ACIP voted to reiterate its core recommendations that annual influenza vaccination is recommended for all persons aged 6 months and older who do not have contraindications.
  • The composition of the 2017–2018 trivalent vaccine includes A/Michigan/45/2015 (H1N1)pdm09-like virus, A/Hong Kong/4801/2014 (H3N2)-like virus, and B/Brisbane/60/2008-like (B Victoria lineage). Quadrivalent vaccines will contain the same viruses, as well as B/Phuket/3073/2013-like (BYamagata lineage) virus.
  • New vaccine products/licensures for 2017–2018 include two vaccines licensed for people ≥18 years of age—Afluria Quadrivalent (Sequirus) and Flublok Quadrivalent (Protein Sciences). In addition, FluLaval Quadrivalent (GSK) is now licensed for children ≥6 months of age, an expanded age range from its previous licensure of ≥3 years of age.
  • ACIP extended the recommendation that live attenuated influenza virus vaccine (LAIV, Flumist, MedImmune) not be used into the 2017–2018 season. The committee anticipates receiving additional data on this topic in October 2017.
  • ACIP now recommends use of Afluria (Seqirus) for persons ≥5 years of age, in line with the vaccine’s FDA licensure.
  • ACIP voted to expand the types of influenza vaccine that may be used for women who are pregnant or who might be pregnant during the upcoming influenza season, noting that these women may receive “any licensed, recommended, and age-appropriate, trivalent or quadrivalent inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV).” The previous recommendation specified use of IIV in this group.
  • The committee also voted to approve the above changes into the Vaccines For Children (VFC) program.

Related Link

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Suspected cases of cholera in Yemen now exceed 200,000, with more than 1,300 deaths

On June 24, the Executive Director of UNICEF and the WHO Director General issued a joint media statement on the cholera epidemic in war-torn Yemen. A selection from the press release is reprinted below:

The rapidly spreading cholera outbreak in Yemen has exceeded 200,000 suspected cases, increasing at an average of 5,000 a day. We are now facing the worst cholera outbreak in the world.

In just two months, cholera has spread to almost every governorate of this war-torn country. Already more than 1,300 people have died—one quarter of them children—and the death toll is expected to rise.


Read the full media statement.

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Countries and partners pledge $1.2 billion to protect 450 million children from polio every year

At the June Rotary convention, global health leaders reaffirmed their commitment to eradicating polio. A selection of a related press release is reprinted below.

Today, global health leaders gathered at the Rotary Convention in Atlanta to reaffirm their commitment to eradicating polio and pledge US$ 1.2 billion to finance efforts to end the disease.

Thirty years ago, polio paralyzed more than 350,000 children each year in more than 125 countries around the world. Thanks to the extraordinary efforts of governments, health workers, donors and the partners of the Global Polio Eradication Initiative (GPEI), a public-private partnership dedicated to ending the disease, the highly contagious virus has now been eliminated in all but three countries: Afghanistan, Nigeria and Pakistan. There have been only five cases to date in 2017...


GPEI press release: Global Leaders Unite to Bring Polio One Step Closer to Eradication: Countries and partners pledge US$ 1.2 billion to protect 450 million children from polio every year (PDF)

Related Links

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Register now! Dr. William L. Atkinson, IAC's associate director for immunization education, will present a webinar on adolescent immunization and the 16-year-old platform on July 10

William L. Atkinson, MD, MPH, IAC's associate director for immunization education, will present a one-hour webinar titled "Adolescent Immunization Update and the 16-year-old Platform" on July 10 at 1:00 p.m. (ET). During his presentation, Dr. Atkinson will review the recommendations for adolescent vaccines, including those recommended at 11–12 years of age and those at age 16.

Register today for the webinar. 

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IAC Spotlight! Explore the new "Favorites" tab at the top of every page on immunize.org

IAC has just made a change to the top of every page of its immunize.org website to make it easier for users to find the most popular sections on the site. A new dropdown tab, "Favorites," was inserted at the left on the dark gray banner that runs atop every page. When users hover over this new tab with their mouse or click on it, the Favorites page content will appear.

The following web sections are offered as choices:

We hope this new tab helps you navigate this IAC website more efficiently!

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Dr. Paul Offit's recent columns in The Daily Beast discuss proposed federal funding cuts for health care and the issue of government-mandated vaccination

As reported in the February 1 issue of IAC Express, Dr. Paul A. Offit, MD, director of Vaccine Education Center (VEC) at Children's Hospital of Philadelphia, is now contributing weekly columns to The Daily Beast. Columns will be about popular issues related to science, not limited to vaccines. This week's thought-provoking column is about the threats to childhood immunization programs and public health funding. Last week's column about government-mandated vaccination is titled When Parents Force the Government’s Hand on Vaccines.

You can follow Dr. Offit’s columns by visiting the relevant archive page on The Daily Beast.

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Due to the Independence Day holiday, the next issue of IAC Express will be published on July 6

The Immunization Action Coalition (IAC) will be closed Monday, July 3, and Tuesday, July 4, for the Independence Day holiday. Consequently, next week's issue of IAC Express will be published on Thursday, July 6, instead of July 5. We thank our readers for their understanding.

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IAC HANDOUTS


IAC updates its parent handout "Vaccinations for Preteens and Teens, Age 11–19 Years"

IAC recently updated its one-page handout for parents titled Vaccinations for Preteens and Teens, Age 11–19 Years. Changes were made to add "Yes," "No," or "Maybe" (as appropriate) before the indications for each vaccine; to add a section for Hib vaccine for unvaccinated teens with certain risk conditions; and to create a separate row for MenB vaccine.

Related Link

IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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IAC updates its two standing orders templates for administering MMR vaccine: the one for children and teens and the one for adults

IAC recently updated the following two resources for healthcare professionals:

These standing orders templates now follows the new IAC standing orders format of incorporating lists in bullet form and also using charts and tables whenever possible (e.g., needle length and gauge; detailed information about scheduling and spacing vaccination for adults, and also for children and teens who fall behind) for increased clarity and readability.

Related Link

  • IAC's Standing Orders web section with standing orders templates for administering all routinely recommended vaccines and for the medical management of vaccine reactions

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IAC revises "Before you vaccinate adults, consider their consider their 'H-A-L-O'!"

IAC recently revised the resource for healthcare professionals titled Before you vaccinate adults, consider their “H-A-L-O”! This piece features a chart to help immunization providers assess possible vaccine indications based on a patient's Health, Age, Lifestyle, and Occupation.

Changes were made to add a risk factor of living in an outbreak area as one of the indicators for HepA, MenACWY, and MenB vaccination; to create a separate section for MenB vaccine; and to add the permissive recommendations for HepA, HepB, and MenB within the "Age Factors" column.

Related Link

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OFFICIAL RELEASES AND ANNOUNCEMENTS


WHO issues position paper about the use of fractional doses of yellow fever vaccine

WHO published Yellow fever vaccine: WHO position on the use of fractional doses—June 2017 in the June 23 issue of its Weekly Epidemiological Record. This is the most recent addition to a WHO-issued series of regularly updated position papers on vaccines that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programs. A sentence from the introductory section is reprinted below.

The current WHO position on the use of yellow fever (YF) vaccine is set out in the 2013 WHO position paper on vaccines and vaccination against YF and those recommendations are unchanged. This addendum to the 2013 position paper pertains specifically to use of fractional dose YF (fYF) vaccination in the context of YF vaccine supply shortages beyond the capacity of the global stockpile.

Related Links

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WORLD NEWS


CDC and WHO report on progress toward containment of poliovirus type 2 in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Global Polio Eradication: Progress Toward Containment of Poliovirus Type 2—Worldwide 2017 in the June 23 issue of MMWR. On the same day, WHO's Weekly Epidemiological Record published a similar article titled Global polio eradication: progress towards containment of poliovirus type 2, worldwide 2017. A media summary of the MMWR article is reprinted below.

After the global certification of wild poliovirus type 2 (PV2) eradication in September 2015, and the withdrawal of Sabin PV2 from the trivalent oral poliovirus vaccine in April 2016, PV2 became an eradicated pathogen. To minimize the risk of inadvertent PV2 release, a Global Action Plan (GAP-III) has been prepared. This Plan requires countries to conduct inventories of PV2 materials and implement a “destroy, transfer, or contain” strategy to eliminate or manage the PV2 risks. Countries are completing the inventories, and are either destroying, transferring, or planning to contain all PV2 materials. Seventy-nine facilities (either vaccine production sites or laboratories) in 30 countries were designated as Poliovirus-Essential Facilities that will continue to manipulate PV2. These facilities are expected to adhere to the GAP-III requirements.

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FEATURED RESOURCES


AAP reorganizes the immunization pages on its website

The American Academy of Pediatrics (AAP) recently reorganized the immunization web pages on its website for healthcare professionals. The navigation was streamlined, with a more logical placement of new resources, to make resources easier to find.

Related Links

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New edition of The Vaccine Handbook: A Practical Guide for Clinicians, a.k.a. "The Purple Book," by Dr. Gary Marshall available for purchase from IAC; free app for iPhones and iPads available from IAC

The 6th edition of The Vaccine Handbook: A Practical Guide for Clinicians ("The Purple Book") is considered a vital source of practical, up-to-date information for vaccine providers and educators. Now printed in color and updated with the latest vaccine information through early 2017, "The Purple Book" draws together the latest vaccine science and guidance into a concise, user-friendly, practical resource for the private office, public health clinic, academic medical center, and hospital.

The sixth edition of this valuable guide (592 pages) is available on IAC's website at www.immunize.org/vaccine-handbook. The price of the handbook is $34.95 per copy, plus shipping charges. Order copies for your staff or for distribution at an upcoming conference.

Discount pricing is available for more than 10 copies. For quotes on larger quantities, email admininfo@immunize.org.

Order your copy today! Click on the image below to visit the "Shop IAC: The Vaccine Handbook" web page.

Order your copy of The Vaccine Handbook today!

The Vaccine Handbook App for Apple iPhones and iPads is available free from IAC. Sorry, the app is not available for android devices. Book purchase is not necessary but registration to obtain the app is required.

The app is fully searchable, allows for bookmarking, highlighting and annotation, and contains hyperlinks to valuable content from nonprofit and governmental sources.

Click on the image below to visit the The Vaccine Handbook App page in the iTunes store.

Download new app!

About the Author
Gary S. Marshall, MD, is professor of pediatrics at the University of Louisville School of Medicine in Kentucky, where he serves as chief of the Division of Pediatric Infectious Diseases and director of the Pediatric Clinical Trials Unit. In addition to being a busy clinician, he is nationally known for his work in the areas of vaccine research, advocacy, and education.

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Still available! IAC's sturdy laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule—order a supply for your healthcare setting today!

IAC's laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. Both schedules are eight pages (i.e., four double-sided pages) and are folded to measure 8.5" x 11".

Laminated Child and Teen Laminated Schedule

Adult Laminated Immunization Schedules

Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.

PRICING
1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email admininfo@immunize.org.

You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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JOURNAL ARTICLES AND NEWSLETTERS


Vaccine Education Center's June newsletter for healthcare professionals includes information about measles, a summary regarding CDC's adult immunization survey, an introduction to ACIP's "General Best Practice Guidelines for Immunization," and more

The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia published its June immunization-focused newsletter. The issue includes the following articles:

Additional resources, including free resources for providers, are available in the full newsletter.

Access the sign-up form to subscribe to Vaccine Update for Healthcare Professionals.

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May issue of CDC's Immunization Works newsletter now available

CDC recently released the May issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

Related Links

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EDUCATION AND TRAINING


CDC's 6-part NetConference series on adult vaccination now archived for viewing at your convenience

This spring, CDC sponsored a 6-part NetConference series on vaccinating adults that addressed key issues related to protecting adults from vaccine-preventable diseases. A collaborative effort between CDC and Maryland’s adult immunization coalition and state immunization program, the "Vaccinating Adults" series featured presentations by experts in promoting, administering, and securing reimbursement for adult immunizations.

The following six segments are now archived and available to view online:
  • Burden of Vaccine-Preventable Diseases in Adults: Medical, Social, and Economic Costs
  • Provider Reimbursement for Adult Immunizations
  • Immunizing Adults: Immunization Schedule, Coverage, and Challenges
  • Immunizing Older Adults and the Chronically Ill
  • Immunizing Pregnant Women, Health Care Personnel, and in the Workplace
  • Clinic Logistics: Vaccine Administration, Storage, and Handling
Access the 2017 Adult NetConference Series.


Reminder: Weekly CDC webinar series on "The Pink Book" chapter topics runs through October 11; register now

CDC is presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of weekly 1-hour webinars that started June 14 and will run though October 11. Recordings of sessions will be available online within 2 weeks after each webinar. All sessions begin at 12:00 p.m. (ET). Continuing education will be available for each event.

The webinar series will provide an overview of vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.

Registration and more information is available on CDC's Pink Book Webinar Series web page.

All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at www.cdc.gov/vaccines/pubs/pinkbook/index.html.

You can also order this resource from the Public Health Foundation for $40 plus shipping and handling. This print version does not include the 2017 supplement.

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CONFERENCES AND MEETINGS


Nevada Health Conference scheduled for November 13–14; one of the tracks will be devoted to topics of interest to coalitions

The 2017 Nevada Health Conference is scheduled for November 13–14 at Green Valley Ranch in Henderson, Nevada (Las Vegas area). The "People. Purpose. Passion: The Roadway to a Healthier Nevada" conference theme highlights innovative and timely health-related topics in the areas of immunization, maternal child health, chronic disease, public health policy, media training, and more.

The Day 1 breakout sessions typically cover current immunization, maternal child health, and chronic disease topics. The Day 2 sessions allow attendees to choose from four session tracks for a day long, deep dive into that subject matter. One of these four tracks will cover coalition-focused topics, such as advocacy, fundraising, best practices, collaboration, and more. As there is no full National Conference for Immunization Coalitions and Partnerships (NCICP) planned for 2017 or 2018, immunization coalition and nonprofit leaders who usually attend NCICP should consider attending the Nevada Health Conference.

Access more information.

Related Link

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Washington Vaccine Update to take place on October 27 in Seattle

The Washington State Department of Health and WithinReach are sponsoring a Washington Vaccine Update conference on October 27 in Seattle. This will be a clinically focused event; topics may include recent outbreaks in Washington State, what’s new in immunizations, strategies for communicating with vaccine-hesitant parents, and more.

Access registration information.

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ASK THE EXPERTS

Question of the Week

How can I get yellow fever vaccine? Is there a vaccine shortage?

Yes, there is a yellow fever vaccine (YF-Vax) shortage. If you are a healthcare provider who administers yellow fever vaccine, you can no longer place an order for YF-Vax online. You must call Sanofi Pasteur at 1-800-VACCINE (1-800-822-2463), and a customer service representative will work with you to determine how many doses can be shipped and which vial sizes (single dose or 5 dose). YF-Vax doses will be prioritized for patients who are traveling in the next 30 days to an area where yellow fever vaccine is required or recommended.
 
Healthcare providers should refer to the section titled Yellow Fever and Malaria Information, by Country (https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/yellow-fever-malaria-information-by-country) in CDC Health Information for International Travel 2018 ("The Yellow Book”) for information about which countries require yellow fever vaccination for entry and for which countries CDC recommends yellow fever vaccination. In the absence of a country requirement, CDC does not recommend yellow fever vaccination if the traveler’s itinerary does not include travel to a yellow fever–endemic area.


This information can be found at https://wwwnc.cdc.gov/travel/news-announcements/yellow-fever-vaccine-shortage-2016.


About IAC's Question of the Week

Each week, IAC Express highlights a new, topical, or important-to-reiterate Q&A. This feature is a cooperative venture between IAC and CDC. William L. Atkinson, MD, MPH, IAC's associate director for immunization education, chooses a new Q&A to feature every week from a set of Q&As prepared by experts at CDC’s National Center for Immunization and Respiratory Diseases.

We hope you enjoy this feature and find it helpful when dealing with difficult real-life scenarios in your vaccination practice. Please encourage your healthcare professional colleagues to sign up to receive IAC Express at www.immunize.org/subscribe.

If you have a question for the CDC immunization experts, you can email them directly at nipinfo@cdc.gov. There is no charge for this service.

Related Links

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About IAC Express
The Immunization Action Coalition welcomes redistribution of this issue of IAC Express or selected articles. When you do so, please add a note that the Immunization Action Coalition is the source of the material and provide a link to this issue.

If you have trouble receiving or displaying IAC Express messages, visit our online help section.

IAC Express is supported in part by Grant No. 6NH23IP922550 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: AstraZeneca, Inc.; bioCSL Inc.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.
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Video of the Week
I Lost My Legs to Meningitis, You Don't Have To: Del Miller is a National Meningitis Association Ambassador who contracted meningitis at age of 31. In emotional terms, Del describes the sudden onset of his symptoms and the severity of his disease complications, which culminated in the amputation of both his legs. He tells the gay community to learn about meningitis and get vaccinated. (Source: CA Public Health)
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Editorial Information
Editor: Deborah L. Wexler, MD
Managing Editor: Teresa Anderson, DDS, MPH
Consulting Editor: Marian Deegan, JD
Assistant Managing Editor: Liv Augusta Anderson, MPP
Issue Abbreviations
AAFP: American Academy of Family Physicians
AAP: American Academy of Pediatrics
ACIP: Advisory Committee on Immunization Practices
CDC: Centers for Disease Control and Prevention
FDA: Food and Drug Administration
IAC: Immunization Action Coalition
MMWR: Morbidity and Mortality Weekly Report
NCIRD: National Center for Immunization and Respiratory Diseases
VIS: Vaccine Information Statement
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